Institute for Health System Science, Northwell Health Feinstein Institutes for Medical Research, Manhasset, New York, USA.
Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA.
J Neurointerv Surg. 2024 Mar 14;16(4):333-341. doi: 10.1136/jnis-2023-020489.
Although patients with COVID-19 have a higher risk of acute ischemic stroke (AIS), the impact on stroke outcomes remains uncertain.
To determine the clinical outcomes of patients with AIS and COVID-19 (AIS-COVID+).
We performed a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Our protocol was registered with the International Prospective Register of Systematic Reviews (CRD42020211977). Systematic searches were last performed on June 3, 2021 in EMBASE, PubMed, Web-of-Science, Scopus, and CINAHL Databases.
(1) studies reporting outcomes on AIS-COVID+; (2) original articles published in 2020 or later; (3) study participants aged ≥18 years.
(1) case reports with <5 patients, abstracts, review articles; (2) studies analyzing novel interventions. Risk of bias was assessed using the Mixed Methods Appraisal Tool. Random-effects models estimated the pooled OR and 95% confidence intervals (95% CI) for mortality, modified Rankin Scale (mRS) score, length of stay (LOS), and discharge disposition.
Of the 43 selected studies, 46.5% (20/43) reported patients with AIS without COVID-19 (AIS-COVID-) for comparison. Random-effects model included 7294 AIS-COVID+ and 158 401 AIS-COVID-. Compared with AIS-COVID-, AIS-COVID+ patients had higher in-hospital mortality (OR=3.87 (95% CI 2.75 to 5.45), P<0.001), less mRS scores 0-2 (OR=0.53 (95% CI 0.46 to 0.62), P<0.001), longer LOS (mean difference=4.21 days (95% CI 1.96 to 6.47), P<0.001), and less home discharge (OR=0.31 (95% CI 0.21 to 0.47), P<0.001).
Patients with AIS-COVID had worse outcomes, with almost fourfold increased mortality, half the odds of mRS scores 0-2, and one-third the odds of home discharge. These findings confirm the significant impact of COVID-19 on early stroke outcomes.
尽管 COVID-19 患者发生急性缺血性脑卒中（AIS）的风险较高，但 COVID-19 对脑卒中结局的影响仍不确定。
旨在确定 AIS 合并 COVID-19（AIS-COVID+）患者的临床结局。
我们按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行了系统综述和荟萃分析。我们的方案已在国际前瞻性系统评价注册（CRD42020211977）中注册。最后一次系统检索是在 2021 年 6 月 3 日在 EMBASE、PubMed、Web-of-Science、Scopus 和 CINAHL 数据库中进行的。
（1）报告 AIS-COVID+患者结局的研究；（2）发表于 2020 年或之后的原始文章；（3）研究参与者年龄≥18 岁。
（1）病例报告＜5 例、摘要、综述文章；（2）分析新干预措施的研究。使用混合方法评价工具评估偏倚风险。使用随机效应模型估计死亡率、改良 Rankin 量表（mRS）评分、住院时间（LOS）和出院去向的合并比值比（OR）和 95%置信区间（95%CI）。
在纳入的 43 项研究中，46.5%（20/43）的研究报告了无 COVID-19 的 AIS 患者（AIS-COVID-）用于比较。随机效应模型纳入了 7294 例 AIS-COVID+和 158401 例 AIS-COVID-患者。与 AIS-COVID-相比，AIS-COVID+患者院内死亡率更高（OR=3.87（95%CI 2.75 至 5.45），P<0.001），mRS 评分 0-2 者较少（OR=0.53（95%CI 0.46 至 0.62），P<0.001），LOS 较长（平均差异=4.21 天（95%CI 1.96 至 6.47），P<0.001），且出院回家者较少（OR=0.31（95%CI 0.21 至 0.47），P<0.001）。
AIS-COVID 患者的结局更差，死亡率几乎增加 4 倍，mRS 评分 0-2 的可能性减半，出院回家的可能性减少三分之一。这些发现证实了 COVID-19 对早期脑卒中结局的显著影响。
